Home
News
Create a Market Sampling
Guidelines Find a Market
Member Application
Safety Guidelines
Insurance Links
Contact Us
2010
CFMA Insurance Application
Due March 6, 2010
Applications after that date must add $25
Click Here for download pdf version
Market
name ________________________________________________________________________
Market physical set up location ________________________________________________________
( list address and city)
Actual 2009 gross income of your market organization from fees and other sales:
$____________
This does not include the sales by your sellers, only income of the market “organization”
itself.
Even if you are a “nonprofit”, you must list any money you collected
for fees, etc.
Subtract sales taxes you collect from sellers and pass on to a city, if any.
New markets should estimate fees and other income you expect this season.
List name of any “additional insured” to be included on your proof
of insurance certificate and fill out a Certificate
Request Form for each additional insured
Please check your lease carefully for the exact wording your landlord requests.
If an additional insured requires that an original certificate be sent to them,
please indicate this on the form.
Changes after the first certificate is issued are subject to a $25 fee.
Please list only landlords or market site property owners or property managers.
If you do not know this info yet, please note below and then notify CFMA as
soon as you do know.
No certificate will be issued until you supply all necessary information.
Each market is allowed up to two additional insureds, any more
will be subject to a $100 fee.
Your farmers’ market “company”, plus any owners, and market
employees are covered by the policy and will not be added as additional insureds.
Additional Insured(s):
_________________________________________________________________________
_________________________________________________________________________
____
Don’t issue my certificate yet. I will let you know when I get the names
finalized.
It
can take seven to ten working days to get a certificate issued, so please plan
ahead.
Enclose the 2010 premium contribution of $300 per market site, payable to CFMA.
Mail to: CFMA c/o Cindy Torres P.O. Box 7293 Boulder, CO 80306
Name
of person supplying above data
Name ________________________________________ Your title______________________________
(please print name)
By signing here, I acknowledge I have read the 2010 CFMA Insurance Information Sheet document, and the 2010 CFMA Safety Guidelines document, and that the above information is correct at the time of submission.
(signature required) __________________________________________
This information will be handled confidentially for insurance purposes only, and may be audited by the insurance company.